Healthcare Provider Details

I. General information

NPI: 1285740399
Provider Name (Legal Business Name): HAYES CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 RED PINE DR
ALPINE UT
84004-1557
US

IV. Provider business mailing address

12 RED PINE DR
ALPINE UT
84004-1557
US

V. Phone/Fax

Practice location:
  • Phone: 801-763-5991
  • Fax:
Mailing address:
  • Phone: 801-763-5991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3758161202
License Number StateUT

VIII. Authorized Official

Name: DR. RANDALL WILLIAM HAYES
Title or Position: PRESIDENT
Credential: DC
Phone: 801-763-5991